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Address newest hospice hot spots when crafting or updating your program.

A robust compliance plan may be the difference between a slap on the wrist and a knock-out punch when it comes to violating the False Claims Act.

In announcing the $1 million settlement with Hernando-Pasco Hospice Inc., the Department of Justice noted that the hospice "failed to implement an adequate compliance program that might have corrected these problems." The DOJ has cited the lack of a compliance plan in numerous settlements including those of Hospice of Kansas and Hospice of Arizona.

The DOJ’s statement may indicate "a heightened awareness … [that] there was no compliance program in place," says Deborah Randall with Deborah Randall Consulting in Washington, D.C.

"The importance of having a bona fide compliance program to help avoid unlawful conduct and build a culture of compliance cannot be emphasized too much," says attorney John Gilliland with The Gilliland Law Firm in Indianapolis.

Your compliance plan should take special care to address current enforcement hot spots for hospice — eligibility, skilled nursing facility residents, increased levels of care (especially GIP), and marketing.

Compliance guidance from the HHS Office of Inspector General is not mandatory for hospices yet, Randall acknowledges. But compliance plans are required for SNFs, HMOs, and in some states, for all providers, she points out. Experts expect other industries, especially home care and hospice, to follow suit in the near future.

Note: The OIG’s compliance guidance for hospices is at . For tips on crafting your plan, see Eli’s HCW, Vol. XIX, No. 29.